Unpacking the learning on consultant-led ward rounds: Lessons from ethnography in paediatrics

Abstract

Introduction: Consultant-led ward round education in a busy paediatric setting is a complex process and is often ad hoc. We aimed to observe ward rounds to better understand the education opportunities available.Methods: Drawing on Argyris and Schön's (1974) theory of action, we used an ethnographic approach to observe 30 general medical ward rounds over a 3-month period, from September to December 2016. For this study we analysed the learning opportunities and the content that is explicitly taught in relation to the domains of professional practice that we espouse to teach.Results: There were many layers of learning potential observed in ward round practice. These included clinical learning, communication, professional skills and identity and institutional cultural context. Clinical learning was prioritised; however, other learning domains remained implicit and were often ignored.Discussion: Our findings highlight great complexity in ward round learning and teaching. There was significant missed educational potential in the ward round environment as well as a need for a major shift in educational focus from clinical to other professional domains. Following Argyris and Schön (1974), it is necessary to examine what we espouse against our actual educational practice. This can inform a planned or structured approach to exploit the maximum potential of ward round learning and teaching.Conclusions: Ward round education is a priority that benefits from observation, reflection and development of new models of practice. If we are not conscious of what we are teaching on rounds, and how this is occurring, we risk losing opportunities to draw on all of the learning potential available.